Letters

Modern treatment for internal haemorrhoids

BMJ 1997; 315 doi: https://doi.org/10.1136/bmj.315.7112.881a (Published 04 October 1997) Cite this as: BMJ 1997;315:881

Day surgery offers permanent cure

  1. Emin Carapeti, Robert Luff research fellowa,
  2. K S Robin Phillips, Consultant surgeona
  1. a St Mark's Hospital for Intestinal and Colorectal Disorders, Harrow, Middlesex HA1 3UJ
  2. b Birmingham City Hospital NHS Trust, Birmingham B18 7QH
  3. c National Procedures Institute, Michigan State College of Human Medicine, 4909 Hedgewood Drive, Midland, MI 48640, USA

    Editor—John L Pfenninger's editorial on modern treatments for haemorrhoids is misleading on many counts.1 Recurrent symptoms are extremely common after outpatient treatment of haemorrhoids, and the usual outcome of this is multiple visits for persistent symptoms. Most studies of these treatments have had only short term follow up. The few studies with long term follow up have shown that non-surgical treatments provide short term relief of symptoms in only a small proportion of patients while often being unpleasant and poorly received by patients.2 3 It is clear from published reports that the modern treatments advocated by Pfenninger require multiple sessions to achieve a small, short lived benefit. This in turn exposes the patient to the hazards and complications of these treatments, which are by no means trivial and can on rare occasions be life threatening.

    Treatments such as cryotherapy and infrared coagulation are poorly evaluated and have been shown in controlled studies to be inferior to banding or surgery as long term solutions.4 They are also more expensive and less readily accepted by most practitioners. On the other hand, recurrence of symptoms is uncommon after …

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